Complex Monteggia Fractures in the Adult Cohort: Injury and Management

J Am Acad Orthop Surg. 2020 Oct 1;28(19):e839-e848. doi: 10.5435/JAAOS-D-19-00625.

Abstract

Monteggia fractures involve proximal ulna fracture associated with a radiocapitellar joint dislocation. The Bado classification is primarily based on the direction of the radial head dislocation. The Jupiter subtype classification of Bado II fractures further characterizes the severity of proximal ulna comminution and the involvement of the coronoid fragment. This latter classification can better prognosticate the challenges of surgical reconstruction and clinical outcomes. Surgery for all adult Monteggia fractures is required to restore the anatomic alignment of the ulna, which indirectly reduces the radiocapitellar joint. The complexity of the injury is considerably increased by comminution of the proximal ulna, the degree of radial head fragmentation, the reduction of the radial head, and ulnohumeral instability. Anatomic reduction is considered critical to achieving a favorable outcome.

Publication types

  • Review

MeSH terms

  • Adult
  • Bone Malalignment / surgery*
  • Bone Plates*
  • Cohort Studies
  • Elbow Joint / physiopathology
  • Elbow Joint / surgery
  • Female
  • Fracture Fixation / methods*
  • Fracture Fixation, Internal / methods*
  • Fractures, Ununited / physiopathology
  • Fractures, Ununited / surgery*
  • Humans
  • Male
  • Monteggia's Fracture / physiopathology
  • Monteggia's Fracture / surgery*
  • Radius / abnormalities*
  • Radius / surgery
  • Range of Motion, Articular
  • Ulna Fractures / physiopathology
  • Ulna Fractures / surgery

Supplementary concepts

  • Radial Heads, Posterior Dislocation Of